
<div class="layui-form" id="edit_hospital_form" lay-filter="edit_hospital_form"  style="padding: 20px 0 0 0;"  >

    <div class="layui-form-item">

        <div class="layui-inline">
            <label class="layui-form-label">商品名称</label>
            <div class="layui-input-inline">
                <input type="text" id = "hospitalName" maxlength="10" lay-verify="required" placeholder="" autocomplete="off" class="layui-input">
            </div>
        </div>

        <div class="layui-inline">
            <label class="layui-form-label">审批状态</label>
            <div class="layui-input-inline">
                <select   id = "hospitalRank"  >
                    <option value="">请选择状态</option>
                    <option value="审批中">审批中</option>
                    <option value="审批失败">审批失败</option>
                    <option value="审批成功">审批成功</option>
                </select>
            </div>
        </div>
    </div>

    <div class="layui-form-item" id="area-picker">
        <div class="layui-form-label">地址</div>
        <div class="layui-input-inline" style="width: 200px;">
            <select name="province" class="province-selector"  lay-filter="province-1">
                <option value="">请选择省</option>
            </select>
        </div>
        <div class="layui-input-inline" style="width: 200px;">
            <select name="city" class="city-selector"  lay-filter="city-1">
                <option value="">请选择市</option>
            </select>
        </div>
        <div class="layui-input-inline" style="width: 200px;">
            <select name="county" class="county-selector"  lay-filter="county-1">
                <option value="">请选择区</option>
            </select>
        </div>

    </div>


    <div class="layui-form-item">
        <div class="layui-inline">
            <label class="layui-form-label">兑换积分</label>
            <div class="layui-input-inline">
                <input type="text" id = "address" maxlength="30"  placeholder="" autocomplete="off" class="layui-input">
            </div>
        </div>
    </div>

    <div class="layui-form-item layui-form-text">
        <label class="layui-form-label">商品信息</label>
        <div class="layui-input-block">
            <textarea placeholder="请输入商品信息" id="info" name="info" class="layui-textarea"></textarea>
        </div>
    </div>

    <div class="layui-form-item">
        <label class="layui-form-label">状态</label>
        <div class="layui-input-block">
            <input type="checkbox" id = "status" checked="" name="status" lay-skin="switch" lay-filter="department_status_form_Switch" lay-text="启用|禁用">
        </div>
    </div>

    <div class="layui-form-item" style="display:none;">
        <button class="layui-btn" id="submit_hospital" lay-submit="" lay-filter="submit_hospital"></button>
    </div>

</div>
